A case of death of a young boy who died due to accidental shooting is reported. The unique feature of this case is that a single bullet resulted in multiple (five) wounds. Although such cases have been reported in literature, the incidence is low. The present case highlights the importance of careful examination of firearm wounds and to keep in mind the possibility of correlation between the distantly present firearm wounds.

The deceased was a 19 year old boy. At the time of incident he was lying on the bed. His father was standing outside the room and cleaning the revolver, when accidentally a shot got fired and hit him. The boy was immediately rushed to the hospital, where he could not be revived and died after 6 hours of the incident. Medico legal autopsy was conducted 15 hours after the death.

Autopsy examination revealed a well-built body of a young boy. Five wounds were present on the body. Two each on the right knee (Photograph 1) and right hand and one on the abdomen with omentum protruding out of the wound (Photograph 2). Initially it appeared that these five wounds were due to three shots that hit at three distant sites on the body. But as per history given by the eyewitness a single shot was fired.

On careful examination of the direction of the wounds and by correlating the wounds (by keeping the body in a posture with knees semi flexed and right hand lying in between the right knee and the trunk) it was found that all the five wounds were in a single line. It was concluded that the single bullet resulted in multiple wounds. The bullet first hit the right knee and came out from its upper part then entered the dorsal aspect of right hand and came out of its palmer aspect and finally hit the abdomen. On exploring the abdominal wound it was found that the bullet entered the abdominal cavity, went upwards and laterally and ruptured the anterior and posterior wall of stomach, then hit the spleen and ruptured the diaphragm and finally entered the left thoracic cavity. It was retrieved from the left 10th inter costal space near para vertebral region. About 1500 ml of clotted and liquid blood was found in the abdominal cavity and 500 ml of blood in the left thoracic cavity. The cause of death was hemorrhagic shock.

The present case is unusual as a single bullet resulted in multiple entry and exit wounds. Although reported in literature, the incidence of such cases is low. The autopsy surgeon should keep in mind the possibility of atypical firearm wounds. Multiple wounds, even at distant sites on the body may correlate to each other. This becomes more challenging in the absence of visit to the site of incidence and incomplete history of the case.

The present case highlights the potential dangers of inadequate care during firearm cleaning which resulted in the tragic death. Elfawal and Awad [1] have reported a study in which 76.4% accidental firearm deaths were due to faulty handling of firearms and in 70.6% cases accidental shooting was done by others.

Easy access to firearms, constitute a true hazard in the community. Very few people survive incidents involving gunshot injuries. Lack of legislative restrictions on guns is often associated with higher fatality rates [2]. Increased control over procurement and possession of guns may help to limit such fatalities [3,5,6].

Studies have indicated that reducing the availability, as well as cultural inacceptance of firearms will help to decrease the fatality rates especially among males [1–4].

A study shows that physicians do not adequately document and interpret gunshot wounds, which may influence the treatment of the patient and have medicolegal consequences. It has been suggested that emphasis should be placed on undergraduate and postgraduate teaching for physicians to correctly identify, interpret and document firearm wounds [7].

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